Full Name of Worker i T toner te" MUITAIMadalol [Wialalalss I I CINALCNo. SISO T= [91s 16 B [31-13] Pate of sith (5]6] lo] | - 1/17 1415) Full Name of Stude i] 1 RalNameot Student (iV lH AMATO Iwi Alal Als eel C.NLCNo, [3 19 55 re of Bi - 1S] Cee, SISIOI=TaToI S416 12I5]=[5] o-teoteith ole] le Us 1/4)a1S) 2) Certified that the below mentioned particulars of the worker of our Establishment,/ Industrial Unit (Complete Name) Lrieic Pu ina RE haterted ta i) He / She falls within the definition of “Worker” as defined in Punjab Industrial Relations Act (IRA), 2010. ey ji) He / She joined this Establishment as (Designation) 4). Lnspecter on of-04-298 and is working till date FT ie. 3s (Designation) QA Jnspectoy ili) He / She died during service on ‘and has been paid death grant of W. W. Fund. (1 iv) He / She retired from service on fe a) due to disability (disability proof through a legal medical board constituted for the o a b)_onattaining the age of superannuation. OR v) He / She was laid off due to closing / nonfunctional / inoperative industry / mining units. 2) Certified that worker is registered with:- i) Employees Old Age Benefits Institution (EOB!) c08i Cord Number_J00A276 108 pr ) Employees Social Security institution (ESS!) SSI R'S Card Number o In case of non-registered workers, an affidavit duly attested by notary public and focal Oo person of the concerned labour department (ie. Dir / Dy, Dir. / Asst: Dir. Labour / AMLWC or his nominee), may be submitted by worker regarding correctness of Particulars given in the application, along with two guarantors, namely employer and CBA President / General Certified that above said Industral / Mine / Establishment s registered under :~ 3) fi ee econo) Ser ii) Punjab Mining Concession Rules, 2002. Mines Registration Number a OR lips paying 2% contribution under section 2 (f) of Workers Welfare Fund Ordinance, 1971 a OR f ~ v)is paying 5% left out contribution under Companies Profit (Workers Participation 3547186 A iy (Attestation by the Employer)